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A - NAPLEX > Chapter 62: Oncology II - Common Cancers & Cancer Treatment > Flashcards

Chapter 62: Oncology II - Common Cancers & Cancer Treatment Flashcards

1
Q

When treatment has destroyed all known tumors

A

Complete response

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2
Q

When at least 30% of the tumor was eliminated

A

Partial response

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3
Q

The majority of adverse effects are due to damaging effects on non-cancerous, rapidly-dividing cells in the:

A

GI tract, hair follicles and bone marrow, where the production of blood cells take place

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4
Q

Which drugs can increase the risk of skin cancer

A

Immunosuppressants (including many transplant drugs)

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5
Q

What does each letter stand for in ABCDE for educating patients on suspicious skin spots?

A 
Asymmetry
Border
Color
Diameter
Evolving
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6
Q

What is the top risk factor for breast cancer

A

Being female

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7
Q

What are the modifiable RF for breast cancer

A

Being overweight (in postmenopausal women)
Low physical activity
Poor nutrition
Tobacco use

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8
Q

Which genes normally suppress tumor growth in breast cancer

A

BRCA1 and BRCA2

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9
Q

Inherited mutations in BRCA1 and BRCA2 prevent:

A

cell repair and causes dramatic increase in breast cancer incidence

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10
Q

What is Klinefelter Syndrome

A

A congenital condition in which males have one Y chromosome and two or more X chromosomes (normally, they only have one X and one Y)
They produce more estrogen than is typical for males & have higher risk of breast cancer

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11
Q

For breast cancer, hormone sensitive (e.g., ER+) cancer for premenopausal women is treated with

A

Tamoxifen

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12
Q

For breast cancer, hormone sensitive (e.g., ER+) cancer for postmenopausal women is treated with

A

Aromatase Inhibitor

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13
Q

What drug class does tamoxifen fall under

A

SERM

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14
Q

Is tamoxifen an estrogen agonist or antagonist in breast cells?

A

Antagonist

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15
Q

MOA of aromatase inhibitors

A

Reduce estrogen production by blocking the aromatase enzyme that catalyzes the conversion of androgens to estrogens

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16
Q

Which SERM is used for breast cancer prevention (NOT treatment)

A

Raloxifene

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17
Q

What is another use of raloxifene & it’s benefit

A

Used for osteoporosis prevention and treatment in postmenopausal women
Increases bone density

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18
Q

Raloxifene is not first-line for osteoporosis because of what SE/risks

A

Hot flashes

Clotting risk

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19
Q

In some circumstances, a premenopausal woman will be put into menopause by taking a GnRH agonist. What is the MOA of GnRH agonists

A

Decrease LH and FSH, which suppresses ovarian estradiol production. This makes aromatase inhibitors a reasonable option

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20
Q

The HER2 oncogene promotes:

A

Breast tumor growth

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21
Q

What formulation does fulvestrant come in

A

IM injection

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22
Q

Tamoxifen should not be used with

A

2D6 inhibitors, such as fluoxetine and paroxetine

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23
Q

What drug can be used with tamoxifen to treat hot flashes

A

Venlafaxine

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24
Q

Tamoxifene boxed warnings

A

Increased risk of uterine or endometrial cancer and thrombotic events (also raloxifene)

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25
Q

Side effects of tamoxifene and fulvestrant

A

hot flashes/night sweats, vaginal bleeding/spotting, vaginal discharge/dryness/pruritis, decreased libido, decreased bone density (premenopausal women) - supplement with calcium/vitamin D

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26
Q

Which SERM drug is teratogenic

A

Tamoxifen

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27
Q

Anastrozole brand name

A

Arimidex

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28
Q

Which drug class has a higher risk of CVD: SERMs or Aromatase Inhibitors

A

AIs

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29
Q

Which drug class has a higher risk of osteoporosis: SERMs or Aromatase Inhibitors

A

AIs

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30
Q

Side effects of aromatase inhibitors

A

Hot flashes/night sweats, arthralgia/myalgia

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31
Q

What drugs are contraindicated with any history of breast cancer

A

Estrogen-containing meds

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32
Q

Androgen deprivation therapy (ADT) for prostate cancer is also called

A

Chemical castration

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33
Q

Androgen deprivation therapy is achieved with either:

A

GnRH antagonist alone or a GnRH agonist (initially taken with an antiandrogen)

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34
Q

Another name for GnRH agonists

A

LHRH agonists

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35
Q

The initial surge of testosterone caused by GnRH agonists is called

A

Tumor flare

Symptoms include bone pain and difficulty urinating

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36
Q

To prevent tumor flares with GnRH agonists, what can be given in combination

A

Antiandrogens for several weeks at the start of a GnRH agonist

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37
Q

Leuprolide brand name

A

Lupron Depot

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38
Q

Goserelin brand name

A

Zoladex

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39
Q

Concerns with GnRH agonists

A

Decrease bone density; supplement with calcium/vitamin D

Tumor flares

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40
Q

GnRH agonist side effects

A

Hot flashes, impotence, gynecomastia, bone pain

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41
Q

Degarelix, a GnRH antagonist, has what concerns

A

Osteoporosis risk

No tumor flares

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42
Q

How to calculate BSA using Mosteller Equation

A

BSA (m2) = √ Ht (cm) x Wt (kg) / 3600

43
Q

Cyclophosphamide and ifosfamide produce a metabolite called ____ that concentrated in the bladder and can cause hemorrhagic cystitis

A

Acrolein

44
Q

Which chemoprotectant inactivates acrolein in the bladder without interfering with the cyctotoxic efficacy of cyclophosphamide and ifosfamide

A

Mesna

45
Q

Between cyclophosphamide and ifosfamide, which drug is ALWAYS given with mesna

A

Ifoafamide

cyclophosphamide is only used with mesna at high doses

46
Q

Busulfan has a side effect of

A

Pulmonary toxicity

47
Q

Dacarbazine turns what color when decomposed

A

pink

48
Q

Mitomycin has a concern for

A

Vesicant

49
Q

Which platinum chemotherapy is associated with the highest incidence of nephrotoxicity

A

Cisplatin

50
Q

Besides nephrotoxicity and CINV, what other concern does cisplatin have

A

Ototoxicity

51
Q

Which chemoprotectant is given prophylactically to prevent cisplatin-induced nephrotoxicity

A

Amifostene (Ethyol)

52
Q

What is the Calvert formula used to dose carboplatin in adults

A

Total carboplatin dose (mg) = Target AUC x (GFR + 25)

53
Q

Using the Calvert formula to dose carboplatin, what is the GFR usually capped at

A

125 mL/min

54
Q

Doses of cisplatin > ____ mg/m2/cycle must be confirmed with a prescriber

A

100

55
Q

Which chemoprotectant is indicated for prevention of doxorubicin-induced cardiotoxicity

A

Dexrazoxane (Zinecard)

remember this brand name bc it has the word “card” in it for cardio

56
Q

What is the antidote for accidental doxorubicin extravasation

A

Dexrazoxane (Totect)

57
Q

Zinecard may be considered when the doxorubicin cumulative dose > ___ mg/m2

A

300

58
Q

What color does doxorubicin turn urine, tears, sweat and saliva

A

Red

59
Q

Mitoxantrone is an anthracendione related to the anthracyclines that turns urine, sclera and other body fluids which color

A

Blue

60
Q

Irinotecan causes acute cholinergic symptoms such as diarrhea, which should be treated with ____. Delayed diarrhea should be treated with ___

A

Atropine

Loperamide

61
Q

Etoposide IV causes:

A

Infusion-rate hypotension: infuse over 30-60 min

62
Q

Etoposide capsules should be

A

Refrigerated

63
Q

T/F: Bleomycin causes myelosuppression

A

False

64
Q

Which vinca alkaloid when given intrathecally will cause progressive paralysis and death

A

Vincristine

65
Q

Which two vinca alkaloids are associated with more bone marrow suppression

A

Vinblastine and vinorelbine

66
Q

VInca alkaloids are potent vesicants and should be treated with _____ if extravasation occurs

A

Warm compresses and hyaluronidase

67
Q

T/F: vinca alkaloids can be given via IV administration

A

True

68
Q

What can occur with all taxanes

A

Severe infusion-related hypersensitivity reactions and fatal anaphylaxis: premedicate

69
Q

Docetaxel can cause severe ___

A

fluid retention

70
Q

All taxanes except paclitaxel should use _____

A

non-PVC bag and tubing

71
Q

Which taxane does not require premedication

A

Paclitaxel

72
Q

Paclitaxel and cabazitaxel should use _____

A

0.22-micron filter

73
Q

What is given with fluorouracil to increase its efficacy

A

Leucovorin

74
Q

Capecitabine brand name

A

Xeloda

75
Q

What increases the risk of severe fluorouracil toxicity

A

DPD deficiency

76
Q

Side effects of 5-FU and capecitabine

A

Hand-foot syndrome, diarrhea, mucositis

77
Q

Methotrexate brand name

A

Trexall

78
Q

Methotrexate doses used for RA/psoriasis are given

A

weekly, not daily

79
Q

High-dose MTX requires

A

Leucovorin rescue

80
Q

Folate antimetabolites interfere with the enzymes involved in the folic acid cycle, blocking purine and pyrimidine biosynthesis during which phase of the cell cycle

A

S phase

81
Q

What antidote will rapidly decrease MTX levels that remain high despite hydration and urinary alkilinazation

A

Glucarpidase

82
Q

Drug interactions with MTX

A

NSAIDs, salicylates

83
Q

Boxed warnings for MTX

A

Myelosuppression, renal damage, hepatotoxicity, GI toxicity, teratogenicity

84
Q

Side effects of the mTOR inhibitor everolimus

A

Mouth ulcers/stomatitis, rash, interstitial lung disease, peripheral edema, dyslipidemia, increased BP

85
Q

Bevacizumab brand name

A

Avastin

86
Q

Concern with bevacizumab (VGEF inhibitor)

A

Impairs wound healing: do not administer for 28 days before or after surgery

87
Q

Bevacizumab boxed warnings

A

Severe/fatal bleeding, GI perforation

88
Q

Trastuzumb brand name

A

Herceptin

89
Q

Monitoring for trastuzumab

A

LVEF (using echo or MUGA scan)

90
Q

Persons using cetuximab need to have what gene

A

KRAS wild type

91
Q

Side effect of cetuximab

A

Acneiform rash - indicates that a patient is expected to have a better response to the drug.
Advise pts to avoid sunlight, use sunscreen. Topical steroids and antibiotics can be given prophylactically

92
Q

Rituximab brand name

A

Rituxan

93
Q

Must premedicate with what drugs when using Rituximab

A

APAP, steroids, diphenhydramine

94
Q

What must be done before giving a patient a TKI

A

PG testing

Oral bioavailability may be altered if taken with food

95
Q

Imatinib brand name

A

Gleevec

96
Q

Someone using imatinib must be positive for which chromosome

A

Philedelphia chromosome (BCR-ABL)

97
Q

Side effect of imatinib

A

Fluid retention

98
Q

To use vemurafenic and dabrafenib in melanoma, patients must be positive for what mutations

A

BRAF V600E or V600K mutation

99
Q

To use afatinib, erlotinib and gefitinib for NSCLC, patients must be positive for what mutation

A

EGFR

100
Q

Side effect for EGFR inhibitors

A

Aceniform rash, which indicates patient is expected to have a better response to the drug

101
Q

To use alectinib, brigatinib, ceritinib, and crizotinib, patients must be positive for which mutation

A

ALK

102
Q

Which chemo agents must be taken with food

A

Imatinib and capcitabine

103
Q

Which chemo agents can be taken without regard to food

A

Tamoxifen and Anastrozole

104
Q

Which chemo agents are teratogens

A

Thalidomide, pomalidomide, and lenalidomide

A - NAPLEX (83 decks)

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